Dorota Chomiczewska-Skóra

Allergy to orthopedic metal implants — A prospective study

ObjectivesEvaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure.Materials and MethodsThe study was conducted in two stages. Stage I (pre-implantation) — 60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) — 48 subjects participated in the same procedures as those conducted in Stage I.ResultsStage I — symptoms of “metal dermatitis” were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II — 10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre- and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants.ConclusionsMetal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

ESSCA results with nickel, cobalt and chromium, 2009–2012

Wolfgang Uter1, Francesca Larese Filon2, Francesca Rui2, Anna Balato3, Mark Wilkinson4, Beata Kr ̧ ecisz5,6, Dorota Chomiczewska-Skora5, Marta Kieć-Świerczyńska5, Marie-Louise A. Schuttelaar7, Peter J. Frosch8,9 and Andreas J. Bircher10 1Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, 91054 Erlangen, Germany, 2Department of Public Health, Occupational Medicine, University of Trieste, 34129 Trieste, Italy, 3Department of Dermatology, University of Naples Federico II, 80131 Naples, Italy, 4Department of Dermatology, Chapel Allerton Hospital, LS7 4SA, Leeds, UK, 5Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland, 6Faculty of Medicine and Health Science, Institute of Medical Science, Jan Kochanowski University, 25-317 Kielce, Poland, 7Department of Dermatology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands, 8previously Department of Dermatology, University of Witten/Herdecke, 58448 Witten, Germany, 9previously Department of Dermatology, Klinikum Dortmund, 44137 Dortmund, Germany, and 10Allergy Unit, Department of Dermatology, University Hospital and University of Basel, 4031 Basel, Switzerland

ESSCA results with the baseline series, 2009-2012: rubber allergens.

Allergic contact dermatitis caused by rubber allergens is common, and causes significant patient morbidity. Contemporary data are important to allow appropriate preventive measures and identification of contact allergy trends.

ESSCA results with the baseline series, 2002-2012: p-phenylenediamine

Allergic contact dermatitis caused by p‐phenylenediamine (PPD) is common among all age groups and both sexes. Monitoring of prevalence and intensity of sensitization is important.

Occupational allergic and irritant contact dermatitis in workers exposed to polyurethane foam

ObjectivesTo evaluate sensitization to chemicals present in work environment after an outbreak of contact dermatitis in workers of vehicle equipment factory, exposed to polyurethane foam, based on 4,4′-diphenylmethane diisocyanate (MDI).Material and MethodsFrom among 300 employees, 21 individuals reporting work-related skin and/or respiratory tract symptoms underwent clinical examination, patch testing, skin prick tests, spirometry and MDI sIgE measurement in serum. Patch tests included isocyanates series, selected rubber additives, metals, fragrances, preservatives, and an antiadhesive agent.ResultsClinical examination revealed current eczema in the area of hands and/or forearms in 10 workers. Positive patch test reactions were found in 10 individuals, the most frequent to diaminodiphenylmethane and 4-phenylenediamine (7 persons). Reactions to an antiadhesive agent were assessed as irritant (5 workers). Except for sensitization to common aeroallergens, no significant abnormalities were found in the remaining tests. Occupational allergic contact dermatitis was diagnosed in 7 workers, irritant contact dermatitis in 10 and coexisiting allergic and irritant contact dermatitis in 3 workers.ConclusionsIn workers manufacturing products from polyurethane foam, attention should be paid to the risk of developing contact dermatitis. Skin problems in our study group were attributable probably to insufficient protection of the skin.

Screening survey of ocular, nasal, respiratory and skin symptoms in manicurists in Poland

OBJECTIVES Manicurists are exposed to various chemicals in nail and skin care products and may develop ocular, nasal, respiratory or skin adverse reactions to them. To investigate the occurrence of ocular, nasal, respiratory and skin problems among manicurists and to identify their causal factors, particularly allergic etiology and occupational origin. MATERIAL AND METHODS Manicurists employed in beauty salons in the central region of Poland were invited to fill in the questionnaire and undergo medical examination, skin prick tests with common aeroallergens, patch tests with European Baseline Series and (Meth)Acrylates Series-Nails and spirometry. RESULTS In the questionnaire adverse nasal symptoms were reported by 70%, ocular - by 58%, respiratory - by 42%, hand eczema - by 43% of manicurists. In the medical interview, the frequency of those complaints was lower: nasal ones - 41%, ocular - 24%, cough - 18%, hand skin dryness - 20%, hand eczema - 6%. Cough and hand skin dryness occurred significantly more frequently than in the case of controls. Contact allergy was found for 41% of manicurists and 35% of controls. The prevalence of nickel sensitization was high in both groups (38% and 27%, respectively). Only 3 manicurists reacted to (meth)acrylates. The frequency of atopic diseases was similar in compared groups. Irritant nasal and respiratory reactions were significantly more prevalent among manicurists (nasal - 18% vs. 2%, p < 0.01; respiratory - 18% vs. 1%, p < 0.001). Work-related nasal irritant reactions were finally diagnosed for 19%, ocular ones - for 13%, respiratory - for 18% and within hand skin - for 23% of manicurists. CONCLUSIONS The frequency of workattributed irritant mucosal and skin symptoms among manicurists is high. Exposure to acrylates is an important source of mucosal irritant reactions while occlusive gloves cause irritation of hand skin. The prevalence of nickel allergy among Polish females is high. Int J Occup Med Environ Health 2017;30(6):887-896.

Preservatives as important etiologic factors of allergic contact dermatitis

BACKGROUND Preservatives present in cosmetics and other industrial products can cause allergic contact dermatitis. The aim of the study was to assess the frequency of allergy to selected preservatives in consecutive patients examined due to contact dermatitis in the Nofer Institute of Occupational Medicine, Łódź, and to establish whether individuals sensitized to formaldehyde react simultaneously to formaldehyde releasers. MATERIAL AND METHODS A group of 405 patients (308 females and 97 males) was examined in 2011-2013. In all participants patch tests with a series of 13 preservatives (paraben mix, formaldehyde, Quaternium 15, chloromethylisothiazolinone/methylisothiazolinone mix, methyldibromoglutaronitrile, diazolidinyl urea, imidazolidinyl urea, DMDM hydantoin, 2-bromo-2-nitropropane-1,3-diol, iodopropynyl butylcarbamate, benzalkonium chloride, sodium metabisulfite, produced by Chemotechnique Diagnostics, Sweden) were performed. RESULTS Of the 405 patients 74 (including 52 females) showed positive results of patch tests. Contact allergy to at least 1 preservative was noted in 47 (11.6%) patients, including 34 (11%) females and 13 (13.4%) males. Methylisothiazolinone proved to be the most frequent sensitizer--4.7% (5.2% females, 3.1% males) while parabens, 2-bromo-2-nitropropane-1,3-diol and imidazolidinyl urea (0.2%) were found to be the least frequent. Fourteen (3.4%) participants, 10 women and 4 men, were allergic to formaldehyde and/or formaldehyde releasers. In 11 (78.6%) of them monovalent hypersensitivity was observed. In 13 (3.2% of the examined group) patients allergy to preservatives might have been of occupational origin. CONCLUSIONS Preservatives, particularly isothiazolinones, are significant causal factors of allergic contact dermatitis, including occupational cases. Individuals sensitized to formaldehyde may react simultaneously to formaldehyde releasers, however, such reactions are relatively rare.

Tissue reaction to the nickel implants in the guinea pigs

ObjectivesThe aim of the study was the assessment of local tolerance to nickel implants during 9 months observation in guinea pigs sensitized to nickel before implantation and non-sensitized ones.Materials and MethodsThree groups of guinea pigs were included in the study: 10 sensitized to nickel by the guinea pig maximization test; 10 previously non-sensitized and 10 in control group. In 20 animals (except control group) the nickel implants were inserted in the muscle of the back. After 9 months of observation, the animals were patch-tested with 5% nickel sulfate. Also percentage of eosinophils in peripheral blood was examined. Next, the tissue surrounding the implant and skin from the area of patch tests were collected for the histological examination.ResultsIn 70% of previously sensitized animals, the patch test confirmed the sensitivity to nickel. In 60% of previously non-sensitized animals, a positive reaction to nickel occurred. The results of patch tests in control group were negative. Percentage of eosinophils in peripheral blood was fourfold higher in animals sensitized to nickel than in control group. In histological examination, in the tissue surrounding the implant a dissimilarity concerning the intensity of cellular infiltration was observed between animals previously allergic and non-allergic to nickel. In the 2 of 10 previously sensitized guinea pigs quite severe inflammatory reactions in the inside of connective tissue capsule were noted which may indicate a local allergic reaction. The histological images of skin collected from the positive patch test site corresponded with the typical allergic contact dermatitis.ConclusionsNickel implants may cause primary sensitization to nickel. The nature of the histological changes in the tissues around the implants in guinea pigs sensitized to nickel may correspond to an allergic reaction. The examination of percentage of eosinophils in blood of guinea pigs may be useful in assessing the allergenic activity of metal alloys containing nickel.